Paget's disease of the nipple is most accurately characterized by which of the following statements?
- A It is always associated with an underlying invasive carcinoma of the breast
- B It arises de novo in the nipple epidermis without any underlying ductal carcinoma
- C Paget cells are HER2-positive in the majority of cases and express EMA and low molecular weight cytokeratins ✓
- D The correct treatment is wide local excision of the nipple without investigating for deeper disease
Correct answer: C. Paget cells are HER2-positive in the majority of cases and express EMA and low molecular weight cytokeratins
Explanation
Paget cells in Paget's disease of the nipple are large adenocarcinoma cells within the nipple epidermis that are HER2-positive in >90% of cases and express EMA (epithelial membrane antigen) and low molecular weight cytokeratins (CAM5.2). They arise from spread of ductal carcinoma cells from deeper ducts. Approximately 50-60% of patients have an underlying invasive carcinoma; the remainder have DCIS. Management requires investigation for underlying breast disease (mammography + MRI) before planning surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.